Provider Demographics
NPI:1134405079
Name:THOMAS, SHATAVIA ALEXANDER (DMFT, LMFT)
Entity type:Individual
Prefix:DR
First Name:SHATAVIA
Middle Name:ALEXANDER
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42198
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-0198
Mailing Address - Country:US
Mailing Address - Phone:404-537-2377
Mailing Address - Fax:
Practice Address - Street 1:950 DANNON VW SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2160
Practice Address - Country:US
Practice Address - Phone:404-537-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001138106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist